This proposal describes programmatic research assessing the effects of the immediate social environment on the child's ability to cope or tendency to show distress during painful medical procedures. There are five assessment studies that will be conducted using a data bank that the author compiled from earlier work. Those data include the reliably coded verbal interactions of 31 pediatric leukemia patients who were undergoing bone marrow aspirations (BMAs) and lumbar punctures (LPs), their parents, and the medical staff who were performing the procedures. Each of the 16,000 vocalization is coded for subject number, phase of the medical procedure, verbal content, affect, and temporal order. Study One has already been completed using Sackett's Lag Analysis. The results indicate the strong influence of adults' vocal content on children's tendency to display coping or distress behaviors. The next investigation will examine the influence of the phase of the medical procedure on the nature of the interactions that occurred. MANOVAs will be used to determine the differences in particular behaviors or groups of behaviors across phases. Correlations will be used to evaluate the relationship between response patterns in one phase with those in later phases. In the third and fourth investigations, children will be grouped on the basis of either the degree of distress they display during the medical procedures, or the proportion of coping behaviors they display. Lag analyses and MANOVAs will then be conducted to more thoroughly understand the differences between behavioral interactions that exist in the high, medium, and low distress groups and the high, medium, and low coping groups. These studies should also help clarify the relationship between coping and distress. In the fifth study, the influence of the parents', as opposed to the staffs', vocal content and affect on the child's behavior will be examined. Lag analyses and MANOVAs will be used to evaluate differential response patterns. Information gained from the assessment studies will then be used to develop comprehensive treatment programs (Study Six) that include training the child in the use of coping skills, and training parents and staff how to better elicit those skills from the trained child. Initially, multiple baseline designs, and later group designs, will be used to evaluate treatment effectiveness.